与乳腺癌手术决策相关的财务成本和负担。
Financial Costs and Burden Related to Decisions for Breast Cancer Surgery.
机构信息
1Duke University, Durham, NC.
2Massachusetts General Hospital, Boston, MA.
出版信息
J Oncol Pract. 2019 Aug;15(8):e666-e676. doi: 10.1200/JOP.18.00796. Epub 2019 Jul 29.
PURPOSE
Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery.
METHODS
Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery.
RESULTS
A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs.
CONCLUSION
Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.
目的
财务毒性是癌症治疗的一个公认的不良后果，但对于女性在面临乳腺癌手术的偏好敏感决策时如何考虑治疗成本，以及手术治疗选择如何影响财务伤害，知之甚少。我们旨在确定财务成本和负担与乳腺癌手术决策的关系。
方法
从妇女军团和姐妹网络中招募了有乳腺癌病史的女性（≥18 岁），让她们完成了一项 88 项的电子调查。使用描述性统计和回归分析来评估成本对乳腺癌手术后手术决策和财务伤害的影响。
结果
共纳入 607 名 0 至 3 期乳腺癌女性。大多数为白人（90%），有私人保险（70%）或医疗保险（25%），大学学历（78%），家庭收入超过 74000 美元（56%）。43%的人接受了保乳手术，25%的人接受了乳房切除术，32%的人接受了双侧乳房切除术，36%的人接受了乳房重建。28%的人报告说，治疗费用影响了他们的手术决策，在年收入 45000 美元的情况下，费用优先于乳房保留或外观。总的来说，35%的人报告说癌症治疗导致了经济负担，78%的人从未与他们的癌症团队讨论过费用。与保乳手术相比，双侧乳房切除术（伴或不伴重建）与更高的债务、显著的灾难性财务负担、与治疗相关的经济困难和就业改变显著相关。在收入最高的人群中，65%的女性在财务上没有准备好，报告的治疗费用高于预期（26%）。
结论
癌症治疗费用影响了乳腺癌手术的决策，同样有效的手术治疗在患者报告的财务负担、债务和对就业的影响方面存在显著差异。成本透明度可以为偏好敏感的手术决策提供信息，并改善以患者为中心的护理。
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